The Effect of Cell Salvage on Bleeding and Transfusion Needs in Cardiac Surgery

Abstract

Introduction. Cell salvaging is well established in the blood management of cardiac patients, but there remain some concerns about its effects on perioperative bleeding and transfusion variables. This randomized controlled study investigated the potential effects of the centrifuged end-product on bleeding, transfusion rates, and other transfusion-related variables in adult cardiac surgery patients submitted to extracorporeal circulation. Materials and Methods. Patients were randomly chosen to receive (cell-salvage group, 99 patients) or not to receive (control group, 110 patients) the centrifuged product of a cell salvage apparatus. Bleeding and transfusion rates according to the universal definition of perioperative bleeding (UDPB) classification, postoperative hemoglobin, coagulation, and oxygenation indices were recorded and compared between the groups. Results. Both groups had almost identical bleeding and transfusion rates (median value: 2 units of red blood cells (RBC) and no units of fresh frozen plasma (FFP) and platelets (PLT) for both groups, p > 0.05 ). Patients in the cell-salvage group presented slightly higher hemoglobin concentrations (10.6 ± 1.1 vs. 10.1 ± 1.7 g/dL, p < 0.05 , respectively) and a tendency towards better oxygenation indices (PaO2/FiO2: 241 ± 94 vs. 207 ± 84, p = 0.013 ) in the postoperative period albeit with a tendency for prolongation of prothrombin time (INR: 1.31 ± 0.18 vs. 1.26 ± 0.12, p = 0.008 ). Conclusion. Within the study’s constraints, the perioperative use of the cell salvage concentrate does not seem to affect bleeding or transfusion variables, although it could probably ameliorate postoperative oxygenation in adult cardiac surgery patients. A tendency to promote coagulation disturbances was detected.

The effectiveness of cell salvage in extracorporeal circulation surgeries in relation to use of health resources after use: A systematic review and meta-analysis

“…In twelve RCTs, involving 2129 participants in both the intervention group (n = 1061) and the control group (n = 1068), the effectiveness of using the Cell Salvage was compared with the control group, where traditional methods based on allogeneic transfusion were employed. Five studies showed a high risk of bias [ 26 , 41 , 43 , 46 ], while one study demonstrated an adequate level of quality [ 29 , 33 , 34 , 36 , 47 ].…”

“…Seven RCTs with a total sample size of 2443 participants, considering the intervention group (n = 1203) and the control group (n = 1239), compared the efficacy of Cell Salvage use with the control group on the number of RBC units (n = 673) and platelets (n = 530). Four studies showed low risk of bias [ 26 , 32 , 34 , 50 ] and two studies showed medium risk of bias [ 43 , 46 ].…”

“… Control: Group consisting of 49 patients, all shed mediastinal blood was discarded. Postoperative re-infusion of autologous red blood cells processed from shed mediastinal blood did not increase bleeding tendency and systemic inflammatory response and was effective in reducing the requirement for allogeneic transfusion, the rate of infective complications and the length of postoperative in-hospital stay Tachias et al,[ 46 ] (2022) (1-) Greece Prospective Randomized clinical trial CS (Haemonetics Cell Saver®) No CS (control) CPB time: p = 0.03*(CS > No CS) Cross-clamp time: p = 0.04*(CS > No CS) Operation time: NA Complications: NA 99 (75/24) 110 (87/23) To investigate the potential effects of the centrifuged end-product on bleeding, transfusion rates, and other transfusion-related variables in adult cardiac surgery patients submitted to extracorporeal circulation. CS: The device was used (Haemonetics Cell Saver®) for all patients collecting lost blood from the moment of pericardiotomy to the ECC, and after ECC weaning to the end of the surgery.…”